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Homoeopathic management of generalised anxiety disorder: A case report
*Corresponding author: Dr. S. Siddamma, Department of Organon of Medicine with Homoeopathic Philosophy, Government Homoeopathic Medical College and Hospital, Bengaluru, Karnataka, India. siddamma.sh1@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Siddamma S, Angadi VM. Homoeopathic management of generalised anxiety disorder: A case report. J Intgr Stand Homoeopathy. 2024;7:181-5. doi: 10.25259/JISH_9_2024
Abstract
Generalised anxiety disorder (GAD) is a condition that is characterised by excessive daily anxiety and worry for ≥6 months about many activities or events. It can adversely affect the quality of life of the patient. Homoeopathic medicines are found to be effective in many mental health issues; hence, this case report is an effort to showcase the positive impact of these medicines in the management of GAD. A 47-year-old female presented with palpitations, mild chest pain, excessive anxiety, and fear about the future. After detailed case-taking, Sepia officinalis, an individualised homoeopathic remedy, was prescribed, followed by the excellent improvement, which is objectively recorded in the Hamilton anxiety rating scale. This case report also reflects on how homoeopathic intervention at the earliest can benefit the patient.
Keywords
Anxiety disorder
Homoeopathy
Sepia officinalis
Hamilton anxiety rating scale
INTRODUCTION
Anxiety disorders are associated with intense subjective distress and social impairment.[1] With a lifetime incidence of up to 11% generalised anxiety disorder (GAD) is the most prevalent anxiety condition among older persons.[2] The most recent estimates of the Global Burden of Anxiety reveal that anxiety disorders explain 10% of the disability-adjusted life years. They high burden, yet receive the lowest proportion of professional treatment of all mental disorders.[1]
Women are affected by it twice as often as men.[3]
A study conducted in 2017 found that out of the 197.3 million Indians with mental disorders, 44.9 million had anxiety disorders.[4]
Aetiology
Stress, diabetes mellitus, or comorbidities such as depression, genetics, environmental factors (child abuse), and substance use disorder.[5]
Associated symptoms
Muscle spasms, trembling, twitching and muscle aches or soreness. Somatic symptoms (e.g., sweating, nausea and diarrhoea). Autonomic system (e.g., accelerated heart rate, shortness of breath and dizziness).[6]
Conventional treatment
Cognitive behavioural therapy (CBT) pharmacological treatment antidepressants, benzodiazepines, anticonvulsants, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).[7] Despite benefits, there are drawbacks to medications such as benzodiazepines treat only acute anxiety symptoms, SNRIs and SSRIs, only 60% of patients show satisfactory improvement and a substantial number of patients have significant residual symptoms.[8] Moreover, there is no clear support for an additive effect of CBT.[7] Homoeopathy can be an effective intervention that can manage and provide long-lasting relief and possible recovery.
Few studies suggest the efficacy of homoeopathy in the treatment of mental diseases:
In an EPI3 cohort study conducted by Grimaldi-Bensouda et al., patients with anxiety and depression disorders choosing to consult GPs who prescribe homeopathy in addition to conventional medicine reported the use of fewer psychotropic drugs and were more likely to experience clinical improvement than patients managed with conventional care; however, the study had a low participation rate and the selection bias was present.[9]
A double-blind, randomised, placebo-controlled pilot trial conducted by Parewa et al. investigated the feasibility of homeopathic treatment for generalized anxiety disorder (GAD). The study found favourable effects on anxiety reduction using individualised homeopathic medicines; however, the sample size was considerably small and it can only be considered as a preliminary trial.[10]
The Hamilton Anxiety Rating Scale (HAM-A) was used to assess the symptoms’ severity and follow-ups. The scale consists of 14 items that measure both physical symptoms and psychiatric symptoms. Each item is given a score on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, where <17 indicates mild, 18–24 mild-to-moderate and 25–30 moderate-to-severe.[11]
CASE REPORT
Patient information
A 47-year-old female patient visited the outpatient department on May 27th, 2023 mainly for the following complaints: palpitations and mild chest pain for 7–8 months. Her symptoms were anxiety and excessive fear.
History of presenting complaint
The patient was apparently healthy 7–8 months ago, and the symptoms such as palpitation and mild chest pain were noticed gradually since then. Anxiety and fear excessive < morning, afternoon. She feels like crying without any cause. Feels tired easily, generalised body pains. Frequent headaches (whole head, dull aching type of pain and > slightly better after having food). Two years ago, she had similar complaints and had taken allopathic medicine from a general practitioner and the symptoms subsided temporarily.
Personal history
Her appetite was reduced, thirst increased. Urine and stools were regular and satisfactory. Perspiration was moderate. Sleep was disturbed and unrefreshing. No particular desires and aversions. Thermally, chilly. Her menstrual cycles were regular, she attained menopause 2 years ago.
Physical examination
In general physical examination and systemic examination of the patient, no abnormality was detected. Mental status examination: (1) level of consciousness: Conscious and oriented. (2) Appearance and behaviour: Appropriately dressed, make eye contact and rapport, co-operative. (3) Speech: Spontaneous, relevant and coherent. (4) Affect and mood: Expresses anxiety and appears anxious. (5) Thought and perception: Worrisome thoughts, repeated. (6) Cognition: Difficulty in concentration, focusing only on anxiety. (7) Insight: Good. (8) Judgement: Good.
Life space investigation
The patient belongs Hindu community of a lower socioeconomic status. Childhood: The patient was in a joint family. After the patient’s father passed away in a road traffic accident, property disputes started and they received harsh criticism and insults from the family members and relocated to a nearby village. She completed her secondary school leaving certificate, dropped out of school due to financial issues and supported her sibling’s education. Married at the age of 24 years, suffered spontaneous abortions. After 6 years conceived and gave birth to a male baby. She experienced similar complaints when there was a financial problem (although, according to her husband, the situation was not bad; she exaggerated and worried). Her son opted for a Bachelor of Science for graduation instead of a Bachelor of Engineering, as she had hoped. This really upset her; she started worrying that his future would be unstable, he would be unable to settle down and he would suffer. She is not talking to her son like earlier. Nature: Responsible, independent, reserved and angered easily over trivial issues; when someone does not listen to her when someone disagrees with her, she will argue and go to any extent to prove her point.
Diagnosis
According to the International Classification of Diseases-11 diagnostic guidelines, the present case fulfills the criteria of GAD with no other comorbidities.
Analysis of symptoms
After analysing the case, thorough symptoms considered were anxiety about the future++, anxiety about the financial condition, of becoming poor. Aggravation in the morning, afternoon. Anger when contradicted. Weeping causeless. Consolation aggravates her. Thirsty, chilly patient. The headache is ameliorated by having food. Appetite reduced and sleep disturbed. A totality of cases was formed and repertorisation was done according to Kent. Synthesis repertory used [Figure 1].
- Repertorial chart.
Prescription
Sepia 200 was prescribed in the beginning, followed by Sepia 1M during follow-up.
Follow-up
Five follow-ups were done. The same is given in Table 1. Significant improvements were noted, and HAM-A also improved, as given in Table 2.
| Date | Symptoms | Prescription |
|---|---|---|
| June 10, 2023 | Anxiety, palpitations-better by 20% Sleep-good, but slight disturbance still present Appetite-slightly improved HAM-A-20 |
Rx Sepia 1M 1 dose PL 15 days |
| June 27, 2023 | Anxiety, palpitations, fear and weeping better by 50% Sleep-good, refreshing Appetite-good HAM-A-14 |
Rx PL 15 days |
| July 18, 2023 | Anxiety, palpitations, etc. better by 80% Generals-good HAM-A-10 |
Rx PL 15 days |
| August 4, 2023 | Pt was feeling better by 90% Generals: Sleep-good, refreshing Appetite-good HAM-A-9 |
Rx PL 1 month |
| September 8, 2023 | Anxiety, palpitation-nil Generals-good HAM-A-4 |
Rx PL 1 month |
HAM-A: Hamilton anxiety rating scale
| Domains | June 10, 2023 | June 27, 2023 | July 18, 2023 | August 4, 2023 | September 8, 2023 |
|---|---|---|---|---|---|
| 1. Anxious mood | 3 | 3 | 2 | 2 | 1 |
| 2. Tension | 3 | 2 | 2 | 2 | 1 |
| 3. Fears | 2 | 1 | 1 | 1 | 1 |
| 4. Insomnia | 2 | 1 | 1 | 1 | 0 |
| 5. Intellectual | 0 | 0 | 0 | 0 | 0 |
| 6. Depressed mood | 1 | 1 | 0 | 0 | 0 |
| 7. Somatic (muscular) | 0 | 0 | 0 | 0 | 0 |
| 8. Somatic (sensory) | 0 | 0 | 0 | 0 | 0 |
| 9. Cardiovascular symptoms | 4 | 3 | 2 | 2 | 1 |
| 10. Respiratory symptoms | 0 | 0 | 0 | ||
| 11. Gastrointestinal symptoms | 2 | 1 | 1 | 1 | 0 |
| 12. Genitourinary symptoms | 0 | 0 | 0 | 0 | 0 |
| 13. Autonomic symptoms | 2 | 1 | 1 | 0 | 0 |
| 14. Behaviour at the interview | 1 | 1 | 0 | 0 | 0 |
| Total | 20 | 14 | 10 | 9 | 4 |
DISCUSSION
The present case was the one with a fairly recent onset, presented with major anxiety states, fear and palpitations. Moreover, the case was taken according to Hahnemann’s guidelines for mental diseases and individualising the patient. According to Hahnemann, mental diseases are one-sided diseases and commonly Psoric origin and, in some cases, psora-syphilitic. Hence, they are difficult to cure. After repertorising the case, Sepia was indicated and the Materia medica was further referred before prescribing. The patient’s concerns such as anxiety about the future, fear of poverty and the underlying cause for all this being the delusion that financially they will suffer terribly, which was interpreted as a delusion, the family will starve.
The main rubrics taken were all related to the mind symptoms of the present state. The patient presents with irrational anxiety, fear and depressed state of mind due to disappointments and the underlying insecurity about finances. Other symptoms such as palpitation, reduced appetite, disturbed sleep, generalised body pains and tiredness, were considered common symptoms. Although anxiety is also a common symptom, the underlying cause (delusion and family starving) that’s triggering such a state is taken as characteristic. Potency started with 200; considering the patient’s susceptibility, 1M was given later, which could have possibly affected speedy recovery. Another factor could be that the disease was of recent onset; hence early intervention might have acted favourably. Along with the therapeutic measures, the patient was provided with counselling advised by Hahnemann in the treatment of mental diseases. HAM recorded reduced intensity of symptoms, the initial score of HAM-A was 20 (moderate-to-severe category), gradually reduced to four (remission stage) by the last follow-up.
CONCLUSION
The individualised homoeopathic medicine had favourably acted upon the patient and she has considerably improved. This case proves the efficacy of homoeopathy in the management of mental health conditions. However, this is a single case report; further studies are required to generalise the findings.
Acknowledgment
Thankful to my PG Guide and professor for the guidance and motivation.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship
Nil.
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